Optimizing Cardiac Rehabilitation by Integrating Sleep Therapeutics

拟议的CDA-2将为候选人Caitlan Tighe博士提供专门的研究计划 职业发展和指导，以支持她成为一名临床研究者的目标， 制定和评估行为睡眠干预措施，以提高老年人的功能和生活质量 患有与衰老有关的疾病的退伍军人。Tighe博士将寻求指导培训，以：1）提高她在以下方面的熟练程度： 设计和进行行为睡眠干预研究的退伍军人与衰老相关的疾病，2） 建立测量身体功能的概念知识和技能（例如，流动性，脆弱性） 和症状（例如，疼痛）相关的生活质量在这些退伍军人，3）扩大她的专业知识， 制定和调整整合到VA门诊康复的行为睡眠干预措施 和专业医疗保健设置，和4）提高她的granitarian，领导，和组织 管理能力这些培训目标得到了她提出的研究的支持，其中 跨诊断睡眠和昼夜节律干预（transdiagnosis sleep and circadian intervention，transS-C）将适用于心脏病患者。 在这一人群中进行了康复和试点测试。心脏康复是一种多组分的次要治疗方法， 针对经历过心脏事件的个人的预防计划，包括心脏手术或 疾病恶化。心脏康复的目标主要围绕着身体的恢复。 通过体育活动、教育和咨询来改善心血管功能和降低心血管风险。 心脏康复患者现在比过去年龄更大，医学上更复杂，这促使 需要扩大心脏康复的范围，以解决心血管疾病以外的因素， 有助于功能和生活质量。睡眠健康与心血管疾病的发病率和死亡率有关， 以及功能和健康相关的生活质量。心脏康复患者通常会经历 睡眠健康尚未正式介入心脏康复。睡眠行为干预 和昼夜节律问题，TransS-C旨在促进不同睡眠问题的睡眠健康， 类型和严重程度，因此有很大的潜力，使那些在心脏康复服务。的 建议的研究计划借鉴了美国国立卫生研究院的行为干预发展阶段模型。研究 目标1将涉及形成性工作，以优化TransS-C手册和方案，以便在心脏中交付 康复，与退伍军人，内容专家和供应商的投入。研究目标2将涉及 采用小样本（N = 10）对改编的TransS-C手册和方案进行初步测试和改进， 参与心脏康复并报告睡眠障碍和/或睡眠相关的退伍军人 损伤研究目标3将涉及一项初步随机试验，以确定可行性、可接受性和 干预方案和研究程序的可行性。心脏康复与睡眠 障碍和/或睡眠相关损害将被随机分配至Trans-C+心脏康复组（n = 25）或 家庭护理（n = 25）。睡眠障碍和睡眠相关损害，残疾和功能，以及健康- 将在3个月和6个月时评估相关生活质量，以确定测量反应性并提供 初步了解治疗效果。

The proposed CDA-2 will provide the candidate, Caitlan Tighe, PhD, with a specialized program of research career development and mentoring to support her goal of becoming a clinical investigator who focuses on developing and evaluating behavioral sleep interventions to enhance functioning and quality of life in older Veterans with aging-related diseases. Dr. Tighe will seek mentored training to: 1) increase her proficiency in the design and conduct of behavioral sleep intervention research in Veterans with aging-related diseases, 2) establish conceptual knowledge and skills in the measurement of physical functioning (e.g., mobility, frailty) and symptoms (e.g., pain) relevant to quality of life in these Veterans, 3) expand her expertise in the development and adaptation of behavioral sleep interventions for integration into VA outpatient rehabilitation and specialty medical care settings, and 4) enhance her grantsmanship, leadership, and organizational management skills. These Training Aims are supported by her proposed research, in which the Transdiagnostic Sleep and Circadian Intervention (TranS-C) will be adapted for delivery to Veterans in Cardiac Rehabilitation and pilot-tested in this population. Cardiac Rehabilitation is a multicomponent secondary prevention program for individuals who have experienced a cardiac event, including a cardiac procedure or an exacerbation of disease. The goals of Cardiac Rehabilitation primarily center around the recovery of physical functioning and the reduction of cardiovascular risk through physical activity, education, and counseling. Patients in Cardiac Rehabilitation are now older and more medically complex than in the past, prompting a need to broaden the scope of Cardiac Rehabilitation to address factors beyond cardiovascular disease that contribute to functioning and quality of life. Sleep health is linked to cardiovascular morbidity and mortality, as well as functioning and health-related quality of life. Cardiac Rehabilitation patients commonly experience poor sleep health yet it is not formally intervened upon in Cardiac Rehabilitation. A behavioral intervention for sleep and circadian problems, TranS-C was designed to promote sleep health across sleep problems of differing types and degrees of severity thus having great potential to benefit those served in Cardiac Rehabilitation. The proposed research plan draws from the NIH Stage Model of behavioral intervention development. Research Aim 1 will involve formative work to optimize the TranS-C manual and protocol for delivery in Cardiac Rehabilitation, with input from Veterans, content experts, and providers. Research Aim 2 will involve a preliminary test and refinement of the adapted TranS-C manual and protocol with a small sample (N=10) of Veterans who are participating in Cardiac Rehabilitation and report sleep disturbance and/or sleep-related impairment. Research Aim 3 will involve a pilot randomized trial to establish the feasibility, acceptability, and plausibility of the intervention protocol and study procedures. Veterans in Cardiac Rehabilitation with sleep disturbance and/or sleep-related impairment will be randomized to TranS-C + Cardiac Rehabilitation (n=25) or Usual Care (n=25). Sleep disturbance and sleep-related impairment, disability and functioning, and health- related quality of life will be assessed at 3- and 6-months to determine measure responsiveness and provide preliminary insight into treatment effects.